# Chubb Global Casualty

## Notice of Election-Paid Loss Retention Program

**Insured's Name:** INTERNATIONAL BUSINESS MACHINE  
**Insured's Address:** One New Orchard Road, Armonk, New York 10504

### A) Schedule of Policies

| Line of Business | Policy Number | Effective Date | Expiration Date | Issuing Company |
|------------------|---------------|---------------|----------------|-----------------|
| Automobile Liability | ISA H2556571A | 05/21/2022 | 05/21/2023 | ACE American Insurance Company |
| General Liability | HDO G72491816 | 05/21/2022 | 05/21/2023 | ACE American Insurance Company |
| General Liability (Canada) | CGL 326131 | 05/21/2022 | 05/21/2023 | Chubb Insurance Company of Canada |
| Owners and Contractors Protective Railroad Liability (Metro North Railroad) | ORP G72951281 | 05/21/2022 | 05/21/2023 | ACE American Insurance Company |

### B) Premium Calculation and Adjustment

#### Policy Number(s): ISA H2556571A

| Premium Component | Estimated Premium ($) | Minimum | Rate | Basis of Adjustment |
|-------------------|-----------------------|---------|------|--------------------|
| Estimated Auto Liability Premium | 101,000 | 100% | N/A | Flat Charge |
| Broker Commission | 0 | | | |
| Total Estimated Written Premium | 101,000 | | | |
| Non-Premium Surcharges & Assessments | 400 | | | |
| Total Estimated Cost | 101,400 | | | |

#### Policy Number(s): HDO G72491816, ORP G72951281

| Premium Component | Estimated Premium ($) | Minimum | Rate | Basis of Adjustment |
|-------------------|-----------------------|---------|------|--------------------|
| Estimated Liability Premium | 103,103 | 100% | N/A | Flat Charge |
| Broker Commission | 0 | | | |
| Total Estimated Written Premium | 103,103 | | | |
| Non-Premium Surcharges & Assessments | 38 | | | |
| Total Estimated Cost | 103,141 | | | |

#### Policy Number(s): CGL 326131

| Premium Component | Estimated Premium ($) | Minimum | Rate | Basis of Adjustment |
|-------------------|-----------------------|---------|------|--------------------|
| Estimated Liability Premium | 3,000 | 100% | N/A | Flat Charge |
| Broker Commission | 0 | | | |
| Total Estimated Written Premium | 3,000 | | | |
| Non-Premium Surcharges & Assessments | Included | | | |
| Total Estimated Cost | 3,000* | | | |

*Canadian premiums and taxes, fees and commission will be billed locally in Canada and must be paid locally in Canada in Canadian dollars. The premiums and limits for the Canadian policies above are in US Dollars.

*Chubb Canada will duplicate the limits and coverages as permitted by Canadian regulation.

INTERNA_05212021_  
04/26/2021  
Notice of Election Page 5 of 46